The Hidden Connection Between Hip and Back Pain and the Pelvic Floor

A lot of people come into the clinic with hip or low back pain that just will not let up. They’ve stretched, strengthened, changed their shoes, swapped their chair, bought a new mattress, etc. Sometimes these things help for a little while, but then pain returns. Other times, though, nothing improves.

When someone tells me they feel like they have tried everything, it usually means this: they’ve been given pieces of care, but not the whole picture. Or they’ve been given a cookie cutter program that doesn’t consider their personal needs and life. In both situations, often we overlook one key piece: the pelvic floor and how the body is working together (or not).

Not the internet version of the pelvic floor with just breathwork and kegels. The real one. The one that actually has something to do with how the hips, spine, and trunk manage the day.

How the pelvic floor fits into hip and back pain

The pelvic floor is part of a group of muscles that has 5 basic functions: support the organs, help stabilize, assist in blood flow/circulation from trunk to legs, intimacy, and sphincteric control. In order for us to achieve the stiffness and stability we need to move, lift, jump, run, laugh, etc, we have to coordinate with the rest of the system and manage the intra-abdominal pressure that exists in the belly. The pelvic floor shares this role with the diaphragm, the deep abdominals, and the muscles around the pelvis and spine.

When that system gets out of sync, the body does an annoyingly good job at letting us know. This may show up as patterns that feel like one-sided hip tightness, grumpy hip flexors, a low back that never fully settles, feeling rigid when taking a deep breath, pain, or something else along these lines.

Research has shown that people with lumbopelvic pain often have some form of pelvic floor involvement. Sometimes the pelvic floor holds more tension than it needs. Sometimes it doesn’t relax well. Sometimes it reacts differently during movements than it should. Now, none of this means it’s the cause of your pain. It simply means it’s involved, and when something is involved, it’s worth evaluating a bit more.

What this looks like in real life

Most people don’t walk in saying, “I think my pelvic floor is contributing to my hip pain,” but they may say something like:

“I stretch daily, but it stays tight.”

“It’s not a pain pain. Just really annoying and nagging.”

“It switches sides.”

“I feel it when I stand too long.”

“It disappears for a bit and then comes right back.”

Many of these people also have a history that fits the picture. This could be a birth that left the pelvis feeling different or a long season of stress. Maybe an old injury that the body just figured out how to work around or pelvic symptoms that have never fully resolved. It could be a back pain bout that came on slowly, but over time kept them from exercising like before. Perhaps it looks like pain with intimacy that was dismissed or chronic constipation or always feeling the need to strain to get poop out.

Patterns rarely come out of nowhere or come on overnight. Often, it takes months or years to see the aftermath.

Why traditional ortho care doesn’t always get you all the way there

Depending on the provider, this could be for a few reasons. The PT could be confined by insurance regulations and don’t have the capacity to individualize treatment effectively. It could be that the provider looks at how the area moves and the areas of pain, and while that can be helpful, it does not always address how the deep support system is handling day-to-day load.

The pelvic floor is part of that support system. If it is holding tension, moving late, or reacting strongly to pressure, your hips and low back will absorb that work. The body can manage that for a while, but eventually something starts talking.

This is not about weakness, bad posture, or the need to “fix your alignment.” Those explanations are outdated and honestly a little dramatic. This is about how your system shares work, how it adapts to stress, and how coordinated your deeper muscles are when you move. And even more, it’s about what you believe your body can handle.

What pelvic floor PT actually assesses

In pelvic PT, we look at:

• how your pelvic floor behaves with breathing and movement

• how your hips and core work together during daily tasks

• how your spine tolerates load

• whether your body is relying on bracing instead of coordinated support

• the history that shaped your patterns, not just the symptom that brought you in

• lifestyle factors

• mobility available

• how well you stabilize during movement

What treatment actually looks like

Treatment is not a list of restrictions. In fact, I try really hard to avoid restricting activity or exercise unless it is absolutely necessary, and even then it’s for as brief as a time as possible. We certainly don’t avoid movements that the body is literally designed to do (bending and lifting, I’m looking at you)…

It’s not a handout we give everyone of three sets of ten exercises that have nothing to do with your goals. It's not just KT taping everything or foam rolling the heck out of your body. We take an active, effective approach to get your pain under control.

Treatment usually involves:

• helping the pelvic floor relax if it has been overworking

• improving how your breath, pelvis, and trunk work together

• building strength and control in a way that supports your life, activities, and goals

• adjusting load or volume so your body stops fighting itself and learning how to adapt and build

• helping you understand what your symptoms actually mean so you stop fearing them

You were designed to live an abundant life, so we’re going to treat your body with that in mind and get you back to confidently moving and showing up in your life.

You’re not starting from scratch

If you’ve done rehab before, that work isn’t wasted. You already built pieces of what you need, it just maybe didn’t take you far enough. We’ll fill in the rest!

We don’t necessarily need to go back to the beginning, but we do need to make sure that foundation is set and you’re ready to progress as high as possible.

When it makes sense to see a pelvic floor PT

It might be time if:

• your hip or back pain keeps returning even with good care

• you always feel like one side is doing more work

• your pain shifts depending on the day or activity

• you have a history of pelvic symptoms that never fully went away

• your body feels strong but still doesn't feel coordinated

• your pain doesn’t match what imaging said

• you want an explanation that actually makes sense

  
  

At Fortis PT, we offer in person and telehealth sessions as well as remote strength and conditioning to get you back to participating fully in your life. Book a consultation today to chat further!